6Immunotherapy in GI cancerGI cancers are immunogenic!!!Present diverse challenges and opportunities for IMTMay develop in an immune suppressive micro-environment that is permissive for commensal microbiotaUsually not associated with carcinogens and high mutation burden, with exceptions…

17Pancreas Cancer May be associated with TILs and TAMsTumor-associated antigens are present and may be detected, e.g.: MesothelinVaccination with GVAX (GM-CSF–secreting tumor cells):Induction of mesothelin-specific T-cell responsesMay correlate with improved outcomeThomas JEM 2004.

24Summary GI cancers are recognized by the immune system:Colorectal Cancer, Gastric Cancer, Pancreas Cancer and Hepatocellular Cancer.Monotherapies may not work well in GI cancers without strong baseline immunogenicity.GI cancers may be targeted by an augmented immune response with clinical benefit in a subset of patients.We need to:Identify patients who respond to immunotherapy, learn why, then focus our future trial designs.study combination approaches that stimulate the immune system (with antigen) and augment the immune response.